5 Months in & Frustrated

Editorial Team / Admin · Mar 14, 2016

That first year as a nurse is a transition period. There's a big jump from nursing school to real world licensed nurse, and the common consensus is that it takes at least a year to feel competent. Do you have a mentor you can check in with? Does your nurse manager provide feedback on how he/she feels you are doing?

Nurse4592 · Mar 17, 2016

Thank you so much for your kind reply. I have heard that before about the first year being the hardest, but I feel like it's even more difficult than it should be. But, who knows, I could be wrong. I seem to have good reviews, but I'm not too happy right now and don't enjoy going to work (more than any other job I've had). I do have a few mentors I'll check in with shortly. Thanks again for your input.

barcode120x, RN, NP · Mar 17, 2016

If I have a D/C, then I WILL be getting a new pt around the same time without fail. It's frustrating to try to balance all the other tasks, then work on D/C'ing a pt with all that comes with it (D/C charting, going over the paperwork with the pt/answering D/C questions). THEN, getting a new admit immediately or a little before the first one is D/C'ed with all the admit charting, assessment, medications, new orders, etc, that comes with the pt. Often, we get pts at or right before shift change (which is not nice, but bearable.) One day, I D/C'd 3 pts and got 3 new pts O_O

Exactly why I dislike day shift and I am YEARS away from ever switching to that shift (actually, I don't think I will ever). I am a new grad as well, almost 3 months on my own, 6 months since I started. They trained us new grads on day (I work DOU/telemetry; mostly cardiac and respiratory patients) and it was just ungodly busy every day on day shift while I was training. But yeah, I'm with you on the DC/admit and I've been there and that's why I like night shift. Rarely do we every DC because most DC are during day shift (which is "safer"). Day shifters hate when you tell them in report that they're most likely going home haha, because they'll have to do DC stuff and admit.

Anyhow, yes, you will start to get your routine as time progresses. I'd say I have a pretty good routine right now in terms of what patients to see first, assessments, meds, nursing skills, etc. I'm still trying to get used to the "change in patient condition" anxiety as well as having to call docs in the early AM. But aside from that, it definitely starts to slowly get better as each shift passes by. Oh btw, just because you can't get a skill done, doesn't mean it should be a let down! Some of my coworkers who are years experienced still have some struggle with nursing skills and often tell me to check the policy/procedure or ask the charge nurse because it's been awhile since they themselves have done that particular skill (the most recent was setting up chest tube suction and what parameters to set the suction at and how to do that; sounds easy yes, but as a new grad I've never handled one and we almost never get that on our floor).

SarahRN2013 · Mar 18, 2016

I also worked on a very similar ortho/med-surg floor (almost entirely ortho) in my first year as a nurse, so I think I can relate to your experience. (You didn't even mention all of the q2h and q4h neurovascular checks and physical labor that all those hip/knee/spine patients require just to get them out of bed or the time spent having to stay within arms reach while they are in the bathroom or on the commode because they're ALL fall risks!) It's a tough patient population in my opinion. I was surprised how much easier (way easier) it was when I got pulled to other med-surg units in my hospital. To this day, I think that the ortho units should have one fewer patients per RN and probably one more NA on the floor for a slightly lower ratio for them too.

As others have said, I wouldn't stress too much about missing out on the less common skills (like your NGT insertion example). I've had some great opportunities to master "dormant" skills as I've moved to new units. I currently work a med-surg/step-down float pool position that is broadening my skills even further. Everyone I work with is pretty amazing about helping out with a skills refresher (with patient demo if needed) and acting as "standby" support for the first time that I do a skill since nursing skills lab. New skills will come with time. When we get an ortho patient on the step-down unit, nurses are always glad to have my experience with braces, activity restrictions and PCA management as a resource for them.

I also had to stay late to finish charting almost every day when I was on the ortho unit. At around the 6 or 7 month mark, my manager told me that most RNs have a "surprise" improvement in their efficiency and then another one around the one year mark. She was right! I really didn't think that I changed anything about my practice, but the amount of time I had to stay late got shorter!

As others have said, nights is generally much easier. (I worked nights on the ortho unit and still had to stay late charting at first.) You get paid more too! If you think you could tolerate it (and there are lots of openings on your unit), perhaps you could trial nights for a pay period?

I also was fairly unhappy with the ortho unit. Not miserable, but it was tough. It was such a relief to realize that when I got pulled to other units with easier patient populations, I was able to get all of my charting done in time. I stuck it out for the year (actually a little more) that is required for a GN and then transferred to a step-down unit where I am thriving and happy most shifts. (Every night, when I jot down my patients scheduled meds and anticipated times for PRN meds, I'm astounded at how much "white space" there are with multiple one-hour blocks with no meds of any kind due or anticipated which gives me time to chart, chart, chart or (gasp!) spend more time with my patients providing care or education.)

Hang in there!

kiszi, RN · Mar 19, 2016

It does sound like a difficult situation.. all those admits...

I can offer a little tip on discharges. When I have a patient who I know is going to be discharged, I will drop bits of information whenever I am in the room. For example, right after the surgeon steps out so it's fresh in their memory, "do you understand how to care for your incision?" As I'm giving their meds, I'm explaining about the new blood thinner. When I help them get to the BSC, I am reinforcing teaching about weight bearing status. I try to foresee potential d/c issues and address them right away. After laying the groundwork, my actual discharge process takes less than five minutes.

ArrowRN, BSN, RN · Mar 19, 2016

You only 5 months in. Your patient ratios are not bad at all. Give it time, it will get better. If you anything like me you are just at the tipping point of being comfortable, you just have to go through it. When you get closer to a year, you will see a big difference. I felt the same way when I started. I work on a busy vascular floor and yeah by the time you finish doing pain med's for the group and all the tasks in between, you think you can sit down to chart, then someone calls and it starts all over again. I'm now 1 year 4 months in, it's not easier, it just your time management skills become way advanced. Sometimes now when I float to other med-surg floors I'm done with everything including charting, I sit and watch the experienced nurses on those floor still running around and can even offer to help out, so you will get better even though it does not seem like it. Do I still stay late and chart still? yes, it all happens to us sometimes, it's not just you.

Rosarosebud1 · Mar 21, 2016

I am a new grad that was hired in an extremely busy ER. Im having a really hard time and am feeling extremely frustrated and discouraged. There is a huge push in our ER to flip patients and charge nurses are constantly moving patients out of rooms into bays until they get a room assigned. Patients disappear for diagnostics and return without being placed on monitors. I'll have an ambulance run sitting outside of a room before I've even discharged the patient who is currently in the room. There are times when the MD has been in a room, given orders, and written discharge instructions before I've even seen the patient because I'm dealing with another time consuming patient with no help. The whole experience is making me doubt my decision to go into nursing. I don't know if it's the stress related to the acuity of the patients, the organization itself, or me being a new grad trying to figure everything out.

Nurse4592 · Mar 23, 2016

I also worked on a very similar ortho/med-surg floor (almost entirely ortho) in my first year as a nurse, so I think I can relate to your experience. (You didn't even mention all of the q2h and q4h neurovascular checks and physical labor that all those hip/knee/spine patients require just to get them out of bed or the time spent having to stay within arms reach while they are in the bathroom or on the commode because they're ALL fall risks!) It's a tough patient population in my opinion. I was surprised how much easier (way easier) it was when I got pulled to other med-surg units in my hospital. To this day, I think that the ortho units should have one fewer patients per RN and probably one more NA on the floor for a slightly lower ratio for them too.
As others have said, I wouldn't stress too much about missing out on the less common skills (like your NGT insertion example). I've had some great opportunities to master "dormant" skills as I've moved to new units. I currently work a med-surg/step-down float pool position that is broadening my skills even further. Everyone I work with is pretty amazing about helping out with a skills refresher (with patient demo if needed) and acting as "standby" support for the first time that I do a skill since nursing skills lab. New skills will come with time. When we get an ortho patient on the step-down unit, nurses are always glad to have my experience with braces, activity restrictions and PCA management as a resource for them.
I also had to stay late to finish charting almost every day when I was on the ortho unit. At around the 6 or 7 month mark, my manager told me that most RNs have a "surprise" improvement in their efficiency and then another one around the one year mark. She was right! I really didn't think that I changed anything about my practice, but the amount of time I had to stay late got shorter!
As others have said, nights is generally much easier. (I worked nights on the ortho unit and still had to stay late charting at first.) You get paid more too! If you think you could tolerate it (and there are lots of openings on your unit), perhaps you could trial nights for a pay period?
I also was fairly unhappy with the ortho unit. Not miserable, but it was tough. It was such a relief to realize that when I got pulled to other units with easier patient populations, I was able to get all of my charting done in time. I stuck it out for the year (actually a little more) that is required for a GN and then transferred to a step-down unit where I am thriving and happy most shifts. (Every night, when I jot down my patients scheduled meds and anticipated times for PRN meds, I'm astounded at how much "white space" there are with multiple one-hour blocks with no meds of any kind due or anticipated which gives me time to chart, chart, chart or (gasp!) spend more time with my patients providing care or education.)
Hang in there!

I *love* this post! Sorry for not replying sooner to you and everyone. I've been pretty busy with work and in a bit of a funk due to work.

SarahRN2013, it's so refreshing because you really do understand, esp. being that you've been on the same type of floor before. Do you (or anything else here) think you learn less during nights? Perhaps, you can learn more during nights being that you can, in theory, sit down more? I've had another new grad say that she has more time to sit down to read the patient's charts and understand the WHY (ex: they had past procedures done) vs. all the task-y things on dayshift.

It is a relief to know that there are other easier units than this and that this is not the be all, end all--that I don't always have to rush, rush, RUSH. Looking forward to a new unit as this one because I do feel it can be pretty negative and too much at times. Thanks for all your wonderful advice! I appreciate your kind words. :)

LadyFree28, BSN, LPN, RN · Mar 23, 2016

I am a new grad that was hired in an extremely busy ER. Im having a really hard time and am feeling extremely frustrated and discouraged. There is a huge push in our ER to flip patients and charge nurses are constantly moving patients out of rooms into bays until they get a room assigned. Patients disappear for diagnostics and return without being placed on monitors. I'll have an ambulance run sitting outside of a room before I've even discharged the patient who is currently in the room. There are times when the MD has been in a room, given orders, and written discharge instructions before I've even seen the patient because I'm dealing with another time consuming patient with no help. The whole experience is making me doubt my decision to go into nursing. I don't know if it's the stress related to the acuity of the patients, the organization itself, or me being a new grad trying to figure everything out.

It's probably a combination of the two.

Your ER is busy- you also have to learn as a new grad your voice before your find your footing; meaning, if you need help, say so; learn to delegate if you have techs-know their role, and get them involved-ED nursing is a team sport-you are not alone.

Also learn to practice the art of "anticipation"-pay attention to what the ESI level chief complaint and your assessment and start to put the pieces together and collaboration with docs and get to know their pattern as well.

ER is a steep learning curve-and you self-studying? If not, do so; the more you self-study in your career, the greater you will be able to succeed in your practice. Reflect on what you seen and learn; get familiar with ENA protocols, get Sheehy's manual and hang out here, and seek out your coworkers as mentors; you can learn from everyone-take what you need, analyze and then shape YOUR practice.

Best wishes.

Nurse4592 · Mar 23, 2016

kiszi: Thanks for your response. I love, love, love these tips and will be incorporating this tip into my D/C's. Much appreciated.

ArrowRN: Thank you for your kind insight. I'll keep pushing through... "just keep swimming, just keep swimming." It's nice to know things will get better.

Roserosebud: I'm sorry this is so difficult for you right now. I definitely get it and have quite often doubted my decision to become an RN, and honestly, still do, but right now we have to: "just keep swimming, just keep swimming" as one of the characters from Finding Nemo says :) Was the ER where you wanted to be? I think Mental Health/Psych is where I want to be--my passion.

qaz99 · Mar 28, 2016

I also worked on a very similar ortho/med-surg floor (almost entirely ortho) in my first year as a nurse, so I think I can relate to your experience. (You didn't even mention all of the q2h and q4h neurovascular checks and physical labor that all those hip/knee/spine patients require just to get them out of bed or the time spent having to stay within arms reach while they are in the bathroom or on the commode because they're ALL fall risks!) It's a tough patient population in my opinion. I was surprised how much easier (way easier) it was when I got pulled to other med-surg units in my hospital. To this day, I think that the ortho units should have one fewer patients per RN and probably one more NA on the floor for a slightly lower ratio for them too.

I'm just about to start my first job in a busy ortho/trauma ward, beyond nervous!

Thanks for the info/words of advice on this thread :)